Healthcare Provider Details

I. General information

NPI: 1194842229
Provider Name (Legal Business Name): COAST TO COAST HEALTHCARE SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 NW 183RD ST
MIAMI FL
33169-4469
US

IV. Provider business mailing address

561 NW 183RD ST
MIAMI FL
33169-4469
US

V. Phone/Fax

Practice location:
  • Phone: 305-999-9295
  • Fax: 305-999-9259
Mailing address:
  • Phone: 305-999-9295
  • Fax: 305-999-9259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number30211096
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number30211118
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JUDY JACKSON
Title or Position: ADMINISTRATOR
Credential: MSN, ARNP
Phone: 305-999-9295